<html><!-- #BeginTemplate "/Templates/base.dwt" -->
<head>
<!-- #BeginEditable "doctitle" -->
<title>RPTS: Encode OR</title>
<!-- #EndEditable -->
<meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1">
</head>
<body>
<table width="75%" border="0" cellpadding="0" cellspacing="0">
  <tr> 
    <td><!-- #BeginEditable "bodytext" -->
      <form name="encodeOR" method="post" action="{self}">
        <p>{receiptNumberMsg}</p>
        <p>Previous OR Number 
          <input type="text" name="number" value="{number}">
          Date 
          <input type="text" name="date" value="{date}" >
          Amount 
          <input type="text" name="amount" value="{amount}">
          <br>
          TD No. 
          <input type="text" name="tdNum" value="{tdNum}">
          <br>
          RPTOP No. 
          <input type="text" name="rptopNum" value="{rptopNum}">
        </p>
        <p>Period Covered (choose only one)<br>
          Annual 
          <input type="radio" name="paymentMode" value="A n n u a l" {checkedAnnual}>&nbsp;&nbsp;
          Q1 
          <input type="radio" name="paymentMode" value="Q1" {checkedQ1}>
          Q2 
          <input type="radio" name="paymentMode" value="Q2" {checkedQ2}>
          Q3 
          <input type="radio" name="paymentMode" value="Q3" {checkedQ3}>
          Q4 
          <input type="radio" name="paymentMode" value="Q4" {checkedQ4}>
        </p> 
        <table width="100%" border="0" cellspacing="0">
          <tr> 
            <td colspan="2">&nbsp;</td>
            <td>Discount % </td>
            <td>Interest %</td>
          </tr>
          <tr> 
            <td>Basic Tax GF (70%) </td>
            <td> 
              <input type="text" name="gf" value="{gf}">
            </td>
            <td> 
              <input type="text" name="discountPct" value="{discountPct}" >
            </td>
            <td> 
              <input type="text" name="penaltyPct" value="{penaltyPct}">
            </td>
          </tr>
          <tr> 
            <td>Basic Tax IB (15%)</td>
            <td colspan="3"> 
              <input type="text" name="ib" value="{ib}">
            </td>
          </tr>
          <tr> 
            <td>Basic Tax CB(15%) </td>
            <td colspan="3"> 
              <input type="text" name="cb" value="{cb}">
              Note: Basic Tax GF + Basic Tax IB + Basic Tax CB = Basic Tax</td>
          </tr>
          <tr> 
            <td>SEF </td>
            <td colspan="3"> 
              <input type="text" name="sef" value="{sef}">
              {sefMsg} </td>
          </tr>
          <tr> 
            <td>P.D.1185</td>
            <td colspan="3"> 
              <input type="text" name="pd1185" value="{pd1185}">
            </td>
          </tr>
          <tr> 
            <td>Date of Payment </td>
            <td colspan="3"> 
              <input type="text" name="paymentDate" value="{paymentDate}">
            </td>
          </tr>
        </table>
        <p> 
          <input type="submit" name="submitOR" value="Submit" >
          <input type="submit" name="submitOR" value="Reset"> 
        </p>
      </form><!-- #EndEditable --></td>
  </tr>
</table>
</body>
<!-- #EndTemplate --></html>
